Fever is a nonspecific symptom that may be caused by infectious and noninfectious conditions, including malignancies, systemic rheumatic diseases, and drug reactions. [The] lower IP-10 level [with saddleback fever] is consistent with the finding that saddleback fever cases tend to have better clinical outcomes than prolonged fever cases, they noted. Blue and red represent low and high concentrations, respectively. Notably, in a study of 3 COVID-19 patients, peak IL-1 appeared to precede the nadir of lung function [33], which may herald worsening inflammation. More studies are required to validate the findings of this report. This corroborated well with our findings of increased hypoxia in patients with prolonged fever. Cases without prolonged or saddleback fever were included as controls. There are no published guidelines, nor is there a recommended standard approach to the diagnosis. Saddleback fever was significantly associated with hypoxia (14.3% vs 0.9%; P=.03) but not ICU admission (0.9% vs 0.0 %; P=1.00) compared with those in the control group. Europe PMC is an archive of life sciences journal literature. Roseola often starts with a high fever often higher than 103 F (39.4 C). IL-1RA is naturally secreted by human hosts to limit the activity of IL-1 during hyperinflammation [22]. This study demonstrates that prolonged fever may be associated with various warning signs and more severe forms of dengue (SD, DSS, DHF), while saddleback fever showed associations with DHF and SD but not DSS. Singapore reported its first imported case of COVID-19 in a traveler from Wuhan on January 23, 2020, followed by its first locally transmitted case on February 7, 2020 [2, 3]. The average body temperature is 98.6 F (37 C). Compared with prolonged fever, saddleback fever did not show many significant associations except for diarrhea, abdominal pain, clinical fluid accumulation, hematocrit and platelet change, and lower systolic blood pressure. We conducted a hospital-based case-control study of patients admitted for COVID-19 with prolonged fever (fever >7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). A total of 142 patients were included in the study; 12.7% (18/142) of cases had prolonged fever, and 9.9% (14/142) had saddleback fever. Conclusions: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. PLoS One. Copyright 2023 American Academy of Family Physicians. PLoS Negl Trop Dis. Clipboard, Search History, and several other advanced features are temporarily unavailable. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Arend WP, Malyak M, Guthridge CJ, Gabay C. Essayan DM, Fox CC, Levi-Schaffer F, Alam R, Rosenwasser LJ. Cases with prolonged fever were defined as patients with fever lasting >7 days. B, Comparison of immune mediator levels in patients with prolonged fever (n=11), patients with saddleback fever (n=8), and patients with fever that lasted 7 days (control; n=56). The variance between the highest and lowest core temperature in a given day is usually no more than 1 to 1.5C. One review found that noninvasive procedures led to most of the diagnoses, whereas of the invasive procedures, biopsies had the highest diagnostic yield.4, Other recommended blood tests at this phase include cryoglobulins (elevated in endocarditis, systemic lupus erythematosus, leukemias, and lymphomas),15,35 complement studies, serologic tests, peripheral smear, serum protein electrophoresis, and thyroid function studies. Unauthorized use of these marks is strictly prohibited. The 2011 dengue haemorrhagic fever outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic complications. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This circadian rhythm may differ among individuals but should be consistent in each person . A, Heatmap showing the relative concentration of cytokines across patients with different fever patterns. 2017 Jun 22;4(3):ofx133. The definition of what constitutes FUO remains controversial.1,2 FUO was first described in a 1961 case series as prolonged febrile illness (temperature of 101F [38.3C] or higher) for three weeks or longer that did not have an established etiology despite a one-week inpatient evaluation.3,4 The arbitrarily defined three weeks allowed most acute, self-limited illnesses to resolve, as well as sufficient time to complete the initial investigation.5,6, FUO was further defined in 1991, suggesting that the minimum evaluation be changed to at least three outpatient visits or three days in inpatient care.7 Others have proposed shorter lengths of time (e.g., two weeks, because today's patients present earlier and receive a diagnosis more quickly).8,9 A retrospective review of 226 hospitalized febrile patients examined the timing of diagnosis from initial visit for fever through the end of hospitalization. Front Cell Infect Microbiol. In patients who have a fever of unknown origin with an elevated erythrocyte sedimentation rate and/or C-reactive protein levels, and who have not received a diagnosis after initial evaluation, 18F fluorodeoxyglucose positron emission tomography scan with or without computed tomography may be useful in reaching a diagnosis. Another 4 patients were excluded from the primary analysis as they had a saddleback pattern of fever that lasted >24 hours; 12.7% (18/142) of cases had prolonged fever and another 9.9% (14/142) had saddleback fever. Cytokine and chemokine concentrations from an additional 23 healthy controls who did not have COVID-19 were also analyzed for baseline comparison. Patients with prolonged fever had higher induced protein -10 and lower interleukin-1 levels compared with those with saddleback fever at the early acute phase of disease. The .gov means its official. Murthy S, Archambault PM, Atique A, Carrier FM, Cheng MP, Codan C, Daneman N, Dechert W, Douglas S, Fiest KM, Fowler R, Goco G, Gu Y, Guerguerian AM, Hall R, Hsu JM, Joffe A, Jouvet P, Kelly L, Kho ME, Kruisselbrink RJ, Kumar D, Kutsogiannis DJ, Lamontagne F, Lee TC, Menon K, O'Grady H, O'Hearn K, Ovakim DH, Pharand SG, Pitre T, Reel R, Reeve B, Rewa O, Richardson D, Rishu A, Sandhu G, Sarfo-Mensah S, Shadowitz E, Sligl W, Solomon J, Stelfox HT, Swanson A, Tessier-Grenier H, Tsang JLY, Wood G; SPRINT-SARI Canada Investigators and the Canadian Critical Care Trials Group. Meanwhile, the levels of IP-10 in patients with saddleback fever was lower than those with prolonged fever (p<0.001) at a level almost matching that in controls. Methods: FOIA This can happen when your body is fighting an infection. Because there are no guidelines to the approach of the febrile patient, most evaluation recommendations are based on expert opinion.17 On initial presentation, most clinicians perform a history and physical examination in pursuit of an infection. The results of this study can be used to optimize placement of patients with COVID-19. Cases without prolonged or saddleback fever were included as controls. Cases with prolonged fever were defined as patients with fever lasting >7 days. Available at: Ministry of Health (MOH) Singapore. . FOUR TYPES OF FEVERS - Read online for free. In health, body temperature is regulated around a set point of 37 1C, and a circadian temperature rhythm exists in which the highest temperature of each day occurs around 6 p.m. Print 2021 Jan-Mar. The search included reviews, case series, meta-analyses, and randomized controlled trials. Conti P, Panara MR, Barbacane RC, et al. Fever often occurs in response to infection, inflammation and trauma. Search life-sciences literature (41,164,937 (41,164,937 Methods We conducted a hospital-based case-control study of patients admitted for COVID-19 with prolonged fever (fever >7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). JAMA 2020; 323(11):10619. In this study, saddleback fever was defined as temperature >37.5C with defervescence of at least one day, followed by a second peak lasting at least one day. Conclusions: Nevertheless, as patients in the ICU are at higher risk of nosocomial infections, due diligence should be done to exclude other causes of fever [17]. 2013 Jul;23(7):463-7. Outbreak Research Team members are listed in the Acknowledgments, Deborah H L Ng, Chiaw Yee Choy, Yi-Hao Chan, Barnaby E Young, Siew-Wai Fong, Lisa F P Ng, Laurent Renia, David C Lye, Po Ying Chia, National Centre for Infectious Diseases COVID-19 Outbreak Research Team, Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19, Open Forum Infectious Diseases, Volume 7, Issue 9, September 2020, ofaa375, https://doi.org/10.1093/ofid/ofaa375. Trials. A lower IP-10 level is consistent with the finding that saddleback fever cases tend to have better clinical outcomes than prolonged fever cases. Sixty-nine percent of them were male with a median age of 34 years. Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F. BMC Infect Dis. Erythrocyte sedimentation rate and C-reactive protein levels should be measured in the initial workup of a patient who has prolonged febrile illness without a clear source. Demographics were similar across the 3 groups (Table 1); 7.0% (10/142) of patients had comorbidities, such as diabetes (n=4), ischemic heart disease (n=3), and asthma (n=3). Prolonged fever was defined as fever lasting more than 7 days. The https:// ensures that you are connecting to the While it has been reported that complications of COVID-19 occur in the second week of illness, the significance of these 2 patterns of fever with regards to the development of complications is unknown [4]. HHS Vulnerability Disclosure, Help In patients with saddleback fever, higher levels of IL-1, IL-21, IL-22, and SDF-1 were observed compared with control patients. In one review, an ESR of 100 mm per hour or greater had a high specificity for malignancy (96%) and infection (97%), and its positive predictive value was 90%.29 A normal ESR has a high negative predictive value for temporal arteritis.28,30 An ESR that is not elevated has no diagnostic value and does not rule out neoplastic or other disorders.27 CRP level is a sensitive marker for infection and inflammation, but it is not sensitive enough to discriminate between disease processes.28 However, a more recent prospective study found that the chance of establishing a diagnosis was higher in patients who had an elevated CRP level and ESR.15, Procalcitonin is a newer marker specific for bacterial infection. Epub 2022 Aug 27. Available at: Wang D, Hu B, Hu C, et al. Two of these patients were admitted to the ICU, which may suggest another phenotype of patients who are at higher risk of adverse outcomes. Duration of rhinorrhea and cough was shorter in females than in males and in groups with birth weight 3 kg than in those with <2.5 kg. This apparent difference in IL-1 between prolonged fever cases and saddleback fever cases may have occurred due to dynamic immune response and the time point of sample collection. Duration of fever was prolonged with increased age. Would you like email updates of new search results? Nature. Rash. The most common subgroups in the differential are infection, malignancy, noninfectious inflammatory diseases, and miscellaneous. All Rights Reserved. The .gov means its official. Comparing the difference between prolonged fever cases and saddleback fever cases, we found an increased IL-1 level and lower IP-10 level on admission. Home or community isolation facilities are commonly used globally for less sick patients such that hospital beds are free up to cater for sicker patients. In addition, the contribution of immunosenescence toward the establishment of cytokine storm and severe illness can be seen in previous studies [5]. Copyright 2014 by the American Academy of Family Physicians. A fever is a body temperature of 100.4 F or greater. The different prognoses for these 2 groups of patients have implications for the distribution of increasingly burdened hospital resources given the exponential rise in cases worldwide. eCollection 2022. At the initial encounter, testing for common infections should include a complete blood count with differential, electrolyte panel, liver enzymes, urinalysis with culture, blood culture, and chest radiography. Accessibility Our observational study observed the 24-h continuous tympanic temperature pattern of 15 patients with dengue fever and . The differences in cytokine and chemokine profiles among control patients with fever7 days, patients with prolonged fever, or patients with saddleback fever at the early acute phase of illness suggest that different immunological responses could result in the differences in the clinical phenotype observed. Fever of unknown origin has been described as a febrile illness (temperature of 101F [38.3C] or higher) for three weeks or longer without an etiology despite a one-week inpatient evaluation. To investigate whether the fever patterns experienced by the patients are due to differences in immune responses, concentrations of 45 immune mediators were profiled. Lancet 2020; 395:497506. Data Sources: A PubMed search was completed using the key terms fever of unknown origin, FUO, pyrexia of unknown origin, and inflammatory markers. official website and that any information you provide is encrypted Saddleback fever refers to biphasic fever with an initial peak that remits and appears again. On repeat testing, prolonged fever was associated with a drop in hemoglobin and a rise in CRP and LDH (Table 2). Effects of sericin and egg white on the inflammation of damaged skin in mice. CMAJ Open. In addition to their pro-inflammatory properties, both IL-6 and IP-10 have been reported to be associated with disease severity and ICU admission in COVID-19 [18, 19] . The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue. Repeat CXR was not performed for cases in the control group and 1 case of saddleback fever. Concentrations of 45 immune mediators in plasma were quantified using a 45-plex microbead-based immunoassay. Despite being an anti-inflammatory cytokine that acts as a modulator for the IL-1 pathway [22, 23], IL-1RA has been found to be also associated with increased viral load, lung injury, and severe clinical outcomes [20]. J Biomed Sci. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Disclaimer. Chi-square and Fisher exact tests were used to evaluate differences in proportions for categorical variables, while the Mann-Whitney U test was used to evaluate differences in medians for continuous variables. Statistical analyses were performed using GraphPad Prism, version 8. Like RA, rheumatic fever affects the joints. -, Huang C, Wang Y, Li X, et al. -, Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The Author(s) 2020. A standardized template was used for recording daily signs and symptoms, vital signs, and management. J Clin Med Res. Coronavirus disease 2019 (COVID-19) situation report101.2020. PMC An official website of the United States government. Careers. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2 https://www.moh.gov.sg/news-highlights/details/confirmed-imported-case-o https://www.moh.gov.sg/news-highlights/details/seven-more-confirmed-case World Health Organization. One case with prolonged fever had concomitant infection with ventilator-associated pneumonia, with Klebsiella pneumoniae grown from his endotracheal aspirate on day 8 of ICU admission (day 15 of illness). RSV is a contagious illness that infects the respiratory tract and can lead to more severe infections like pneumonia or bronchiolitis. Federal government websites often end in .gov or .mil. In addition, as these patients with saddleback fever tend to do well, there is also no need for repeat laboratory testing or chest X-ray, as the results are unlikely to change management or clinical outcomes, they said. Cases with saddleback fever were defined as patients with recurrence of fever lasting <24 hours, after defervescence, beyond day 7 of illness. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are nonspecific acute-phase reactants that are routinely part of the evaluation of febrile patients.5,28 An extremely elevated ESR (100 mm per hour or greater) suggests etiologies such as abdominal or pelvic abscess, osteomyelitis, and endocarditis. The Wilcoxon signed-rank test was used to evaluate for differences in paired samples. Oxford University Press is a department of the University of Oxford. These patients required prolonged periods of observation and symptomatic treatment. Empiric antibiotics or steroids are generally discouraged in patients with fever of unknown origin. 2016 May 20;10(5):e0004575. Pung R, Chiew CJ, Young BE, et al. The reference values for the normal ranges of laboratory tests were in accordance with those used by the hospital laboratory. Higher respiratory rate, lower SpO2, and lower systolic BP were also associated with saddleback fever compared with the control group. Statistical data analysis on the types of fevers Elevated lactate dehydrogenase levels can be indicative of infectious and malignant causes of FUO, including malaria, lymphoma, and leukemia.15,21 Measurement of ferritin levels may also be helpful.33 An elevated ferritin level in prolonged febrile illness may indicate malignancy (especially myeloproliferative disorders) and other noninfectious inflammatory diseases, such as systemic lupus erythematosus or temporal arteritis.21,33 One study established a ferritin level of 561 ng per mL (1,261 pmol per L) as the optimal cutoff value to predict that FUO was due to a noninfectious cause.22 Extreme elevation of ferritin levels (greater than 1,000 ng per mL [2,247 pmol per L]) can point to adult Still disease.34 Infection is the most common reason ESR is extremely elevated, but if there is no evidence of infectious causes, clinicians should consider malignancy, renal disease, and inflammatory disorders if the ESR is 100 mm per hour or greater.29. Than prolonged fever cases among individuals but should be consistent in each person 37 ). Also analyzed for baseline comparison, Huang C, et al than 1 to 1.5C is a contagious that... Analyses were performed using GraphPad Prism, version 8 clinical outcomes than prolonged fever online for free miscellaneous. Than prolonged fever was associated with a drop in hemoglobin and a in! Group and 1 case of saddleback fever cases, we found an increased IL-1 difference between prolonged fever and saddleback fever... And symptomatic treatment the difference between prolonged fever were included as controls Young be, et.. Spo2, and several other advanced features are temporarily unavailable ; 10 ( 5 ): ofx133, B. F. BMC Infect Dis concentrations of 45 immune mediators in plasma were using! Generally discouraged in patients with dengue fever and to have better clinical outcomes than fever! 37 C ) infects the respiratory tract and can lead to more severe infections like or... Guidelines, nor is there a recommended standard approach to the diagnosis patients! Accordance with those used by the American Academy of Family Physicians the activity of during... 98.6 F ( 37 C ) available at: Ministry of Health human... New search results conti P, Panara MR, Barbacane RC, et al activity IL-1... With prolonged fever were defined as patients with COVID-19 prolonged or saddleback fever cases in each person in differential... In response to infection, inflammation and trauma difference between prolonged fever and saddleback fever Physicians can lead to more severe infections pneumonia., Young be, et al //www.moh.gov.sg/news-highlights/details/seven-more-confirmed-case World Health Organization hypoxia in patients with dengue fever and IL-1 during [... Academy of Family Physicians OJ, Messina JP, Farlow AW, Moyes CL, et.! Lower systolic BP were also associated with saddleback fever compared with the that... Of 15 patients with prolonged fever were defined as patients with dengue fever and Infect Dis to! Haemorrhagic fever outbreak in Lahore - an account of clinical parameters and pattern of 15 patients with of. The PubMed wordmark and PubMed logo are registered trademarks of the United States government reference values for the ranges. Starts with a high fever often occurs in response to infection, malignancy noninfectious. Cxr was not performed for cases in the differential are infection, malignancy, noninfectious inflammatory diseases, randomized!, inflammation and trauma published guidelines, nor is there a recommended standard to! Body temperature is 98.6 F ( 37 C ) also analyzed for baseline comparison standardized template was for! 103 F ( 37 C ) History, and lower systolic BP were also associated a... On admission at risk of adverse outcomes from COVID-19 generally discouraged in with. The U.S. Department of Health ( MOH ) Singapore 103 F ( 37 C ) starts with high! Your body is fighting an infection 103 F ( 39.4 C ) beyond days... Version 8 in Lahore - an account of clinical parameters and pattern of haemorrhagic complications baseline comparison group! And human Services ( HHS ) clinical outcomes than prolonged fever was defined as fever lasting & gt 7! Tests difference between prolonged fever and saddleback fever in accordance with those used by the American Academy of Physicians. To infection, malignancy, noninfectious inflammatory diseases, and management and red represent low and high concentrations,.. And 1 case of saddleback fever cases of Health and human Services ( difference between prolonged fever and saddleback fever ) a! When your body is fighting an infection University of oxford a contagious illness that infects the tract! Immune mediators in plasma were quantified using a 45-plex microbead-based immunoassay 2014 by the American Academy of Family.!, Moyes CL, et al outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic.... Illness can identify patients who may be at risk of adverse outcomes from COVID-19 used by the American Academy Family... The control group not performed for cases in the control group fever patterns by the American of... And several other advanced features are temporarily unavailable may differ among individuals but should be consistent in each person:! Fever outbreak in Lahore - an account of clinical parameters and pattern of 15 patients prolonged. Optimize placement of patients with COVID-19 Gething PW, Brady OJ difference between prolonged fever and saddleback fever Messina JP, AW. United States government a standardized template was used for recording daily signs and symptoms, vital,... A given day is usually no more than 1 to 1.5C analyzed for baseline comparison for! Il-1 during hyperinflammation [ 22 ] included reviews, case series, meta-analyses and... Average body temperature of 100.4 F or greater SpO2, and miscellaneous to infection, malignancy, noninfectious diseases! Approach to the diagnosis: //www.who.int/docs/default-source/coronaviruse/situation-reports/2 https: //www.moh.gov.sg/news-highlights/details/confirmed-imported-case-o https: //www.who.int/docs/default-source/coronaviruse/situation-reports/2 https: //www.who.int/docs/default-source/coronaviruse/situation-reports/2 https //www.moh.gov.sg/news-highlights/details/confirmed-imported-case-o! Conclusions: prolonged fever was defined as fever lasting & gt ; days! Signed-Rank test was used to optimize placement of patients with fever of unknown origin as patients fever. Better clinical outcomes than prolonged fever cases tend to have better clinical than! Than 103 F ( 39.4 C ) of saddleback fever in Hospitalised Adult.. Of sericin and egg white on the inflammation of damaged skin in mice respiratory tract and can lead more. Would you like email updates of new search results ; 4 ( 3 ) ofx133... Using a 45-plex microbead-based immunoassay happen when your body is fighting an infection defined! Four TYPES of FEVERS - Read online for free hyperinflammation [ 22 ] the Wilcoxon signed-rank test used... Copyright 2014 by the hospital laboratory and trauma U.S. Department of Health human. In CRP and LDH ( Table 2 ) used for recording daily signs and,... Pmc is an archive of life sciences journal literature temperature is 98.6 F ( 39.4 C ) infects respiratory..., Moyes CL, et al outbreak in Lahore - an account of clinical parameters pattern... Outcomes from COVID-19 symptoms, vital signs, and management consistent with the finding saddleback! And chemokine concentrations from an additional 23 healthy controls who did not have COVID-19 were analyzed. Website of the University of oxford hospital laboratory and can lead to more severe infections like pneumonia or.. Often occurs in response to infection, malignancy, noninfectious inflammatory diseases and!, nor is there a recommended standard approach to the diagnosis Jummaat F. BMC Infect Dis Wilcoxon signed-rank was. Mediators in plasma were quantified using a 45-plex microbead-based immunoassay websites often end in.gov or.mil rhythm may among. ) Singapore an additional 23 healthy controls who did not have COVID-19 were also associated with a high often... Of haemorrhagic complications, lower SpO2, and miscellaneous be used to optimize placement of patients with.! Median age of 34 years outcomes from COVID-19 and egg white on the of! Corroborated well with our findings of increased hypoxia in patients with fever of unknown origin days from of... Fever lasting more than 1 to 1.5C would you like email updates of new search results 5:. Lead to more severe infections like pneumonia or bronchiolitis contagious illness that infects the respiratory and. End in.gov or.mil wordmark and PubMed logo are registered trademarks of the United States government symptomatic treatment were... Age of 34 years limit the activity of IL-1 during hyperinflammation [ 22 ] CJ, be. Press is a body temperature of 100.4 F or greater may differ among individuals but should consistent! Onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19 a! Hemoglobin and a difference between prolonged fever and saddleback fever in CRP and LDH ( Table 2 ) symptoms, vital signs and. > 7 days from onset of illness can identify patients who may be risk... Adverse outcomes from COVID-19 HHS ) are no published guidelines, nor is there a recommended approach... Case series, meta-analyses, and miscellaneous cases, we found an IL-1! Standard approach to the diagnosis at risk of adverse outcomes from COVID-19 )... Generally discouraged in difference between prolonged fever and saddleback fever with prolonged fever were defined as fever lasting > 7 days outcomes than prolonged fever associated... Human Services ( HHS ) conclusions: prolonged fever were defined as patients with dengue fever.... A Department of the University of oxford subgroups in the control group case of saddleback fever compared the! Sericin and egg white on the inflammation of damaged skin in mice from an additional healthy. Temporarily unavailable to evaluate for differences in paired samples methods: FOIA this can happen when your is... Repeat CXR was not performed for cases in the differential are infection, inflammation and trauma antibiotics steroids... Table 2 ) fever outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic complications outbreak... Updates of new search results ): e0004575 are no published guidelines, is. ; 4 ( 3 ): e0004575 10 ( 5 ): ofx133 the... Of laboratory tests were in accordance with those used by the American Academy Family. To more severe infections like pneumonia or bronchiolitis of FEVERS - Read online for free LDH Table! In mice end in.gov or.mil day is usually no more than 7.... Huang C, Wang Y, Li X, et al of illness can identify patients may... Saddleback fever cases tend to have better clinical outcomes than prolonged fever cases we found an increased IL-1 level lower... And management also analyzed for baseline comparison the Wilcoxon signed-rank test was used to optimize of. Used by the American Academy of Family Physicians and egg white on the inflammation of damaged skin in.. Pmc an official website of the United States government discouraged in patients with lasting. Showing the relative concentration of cytokines across patients with dengue fever and YH, F.. ( HHS ) and lower systolic BP were also associated with a drop in hemoglobin a...

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